Thursday, December 31, 2009

Mrs. Soma is well known to our call rotation. When Dr. Brain isn't on, she routinely tries to get a remarkable variety of pain relievers from the rest of us. She's been shut down many times in the past, but is remarkably optimistic (or forgetful) and keeps trying.

So it was no surprise when Dr. Brain's answering service relayed a message that she was looking for Vicodin. I called her back, and said no. She asked if there was another doctor she could talk to (she always does). I said no and hung up.

Ten minutes later I get called by the answering service again:

Dr. Grumpy: "This is Dr. Grumpy."

Ms. Supervisor: "Yes, I'm the service supervisor. Mrs. Soma called back, and says she needs Vicodin."

Dr. Grumpy: "I told her no."

Ms. Supervisor: "But she called back and asked again."

Dr. Grumpy: "The answer is still no."

Ms. Supervisor: "She sounds awful!"

Dr. Grumpy: "She always does. She's been doing this for over 10 years."

Ms. Supervisor: "Well, I"m tired of her calling my operators. We have a lot of calls to answer."

I try to work within my patient's means as much as possible. If they have crappy (or no) insurance, I try to use the cheapest generic medication possible.

Dr. Cortex, however, uses a lot of brand-new, pricey Wonderdrugs, mainly because he has samples to give out. The problem here is that he also sees A LOT of Medicaid-subplan indigent patients, and once the patient runs out of samples there is NO FREAKING WAY the plan will pay for the prescription.

Normally, this is a problem between he and his patients. Except when he's out of town. Like now.

So Mr. Ictal runs out of expensive Wonderdrug samples for his epilepsy. Dr. Cortex's nurse calls in a script to Local Pharmacy. Local Pharmacy finds out Wonderdrug isn't covered by his Medicaid plan, and tells Mr. Ictal it'll be $400.

So Mr. Ictal calls Dr. Cortex's office. And his staff closed the office to take a 4-day New Year's weekend (which they weren't supposed to, but figured the boss was in Brazil, so who cares?). And so the answering service routes him to me (my office is closed for the 4-day weekend, too).

Wonderdrug won't be covered without a doctor begging, pleading, and filling out a 30 page form. I call the Medicaid subplan to at least beg. But I'm not contracted with that subplan myself, so they won't even talk to me.

The pharmacy (understandably) can't afford to take the loss on a $400/month pill that they know won't get reimbursed. And Mr. Ictal can't afford this at all. And he has 1 sample pill left, and it's pretty damn dangerous for epilepsy patients to stop their meds cold turkey. And he has no idea what he's taken in the past. And I really hate to change meds on a patient I know nothing about. And his chart is locked up in Dr. Cortex's office until next week.

I feel bad for Mr. Ictal. This insanity (mostly) isn't his fault.

What did I do?

Fortunately, I live close to my (closed) office. So I drove down there this morning to meet Mr. Cortex, and gave him enough samples of Wonderdrug so he won't run out before Dr. Cortex can get back and decide what to do. But this is me (and at least I had samples). In all honesty, most other docs wouldn't care, and say they can't help him. Or would tell him to put the pills on a credit card. Or say it's the pharmacy's issue and to call them. Or to go to an ER (I have no idea why he should go to ER for this, but it's amazing how many docs send patients there for stupid shit like this).

The bottom line here is that you should try to work within your patients' means as best you can. It prevents crap like this from happening, and your call partners will be grateful.

I'm sorry that your regular neurologist is closed/on vacation/dead until after New Years, and that you don't like the doctor covering for them.

But I'm not some sort of neurological urgent care. Showing up at my office without any old records because of some acute issue you need addressed, and planning to return to your previous doc as soon as they get back, doesn't fly here.

I mean, I have my own patients to take care of, and it's not like you're planning to stay with my practice. You make it pretty clear that you're just coming for me to patch things up until Dr. Wondrous returns/detoxes/is resurrected next week. There's a doctor on call for him. SO CALL THEM, NOT ME!

And I'm really pissed off at your internist for participating in this. He tells you to come see me until Dr. Wondrous comes back, because he doesn't know what to do, and he doesn't know Dr. On-Call, and so he sends me a note that says something like "please manage meds until regular doc returns" or "patient has had neck pain since 1972, please do something about it in Dr. Wondrous absence". These notes are especially grating when written by an internist who never refers to me anyway.

Of course, I have none of your past records, and Dr. Wondrous staff is gone, too, and you have no freaking idea what you've tried before, or if it worked, or what tests you've had done.

This is why we have call groups people. I'm sorry if you don't like the person who covers for your regular neurologist. Tell them when they come back. But I am not providing temporary coverage for them.

Monday, December 28, 2009

In the early 80's, when I was in high school, we had to take these career guidance tests. You answered a bunch of questions, and a computer (like a TRS-80: anyone else out there have one? I had the top-of-the-line model, with a whopping 16K of RAM) would tell you what career was best suited to your personality.

My test results suggested a career in farming and agriculture was best for me. (Oddly, so did my Dad's tests in the 1950's. And he's a lawyer now).

In October I put a resume up on a medical site, looking for research work in addition to my regular practice.

Today I got an email from the site's "job assistant", saying that I'm qualified for an exciting career as a Certified Nursing Assistant, and should register for classes NOW.

LOOK! Just because you people waited until the END OF THE FREAKING YEAR to see if you met your insurance deductible, does NOT make it an emergency here for Annie and I.

I don't care that you now need the test (which I ordered 6 months ago) urgently because your insurance is changing, or because you finally met your deductible, or you just looked at a calender for the first time in 6 months and had forgotten December is the last month of the year, OR WHATEVER.

These are not tests you can generally get Bozo Insurance, Inc. to authorize and schedule in under a week, let alone a few days.

And the auth department at Bozo Insurance, Inc. is running half-staffed right now so their people can go on vacation, or get their tests done, or whatever. So auths are slow right now.

A lack of preparation on your part does not constitute an emergency on ours.

And don't give me the line about how you had no idea the end of the year was coming, either.

I just wanted to write and thank you for the tray of homemade chocolate brownies that you brought my office last week.

I'm well aware of your fondness for improvising new recipes, and the staff and I appreciate you telling us which brownies had jalapeños in them, which had bacon, and which had both.

As always, you've outdone yourself. Many of us here thought you'd never be able to top your 2007 tray of chili-pepper-and-white-chocolate-cookies, but we underestimated you and your fondness for spicy foods.

As you can imagine, your unique brownies didn't last long in our breakroom, and quickly disappeared.

You work so hard in the kitchen around the holidays, perhaps next year you should take a break and just rest. You've earned it.

So this morning I'm updating my iTunes software. A friend had told me about this a while back, but I'd never looked for it before today (hell, who actually reads the consents that come with software updates?). But, there it was.

I direct you to item #10 of the iTunes update agreement.

(click to enlarge)

I really love the last line. "You also agree that you will not use these products for any purposes prohibited by United States law, including, without limitation, the development, design, manufacture, or productions of missiles, or nuclear, chemical, or biological weapons."

I freely admit that my taste in music doesn't suit everyone (Mrs. Grumpy hates it), but I think the most that could be said is that my iPod constitutes a weapon of mass good taste destruction.

The morning after Christmas I got dragged in to the hospital to see a guy for headaches.

He kept referring to he and his wife as having "a traditional Christmas", which apparently landed him in the hospital. "Traditional" obviously varies from person to person. Here is how Mr. Traditional and his wife spent their traditional Christmas (and it took A LOT of coaxing to get the whole story out).

They woke up on Christmas morning. Then:

They had a traditional cup of coffee. Then:

They had a traditional exchange of gifts. Then:

They had several traditional shots of scotch. Then:

They smoked a few traditional joints. Then:

They did a few traditional lines of cocaine. Then:

She gave him a traditional under-the-mistletoe blowjob. Then:

When he blew his traditional load he had sudden onset of the-worst-headache-of-his-life (not a tradition).

He was taken to ER, where he had a traditional head CT, MRI, and MRA (having to drag in an MRI tech on Christmas).

So then he had a traditional spinal tap. Which was equivocal, because he wouldn't hold still.

So then the angiogram team got called in on Christmas.

So then he had a traditional 4-vessel cerebral angiogram, complicated by bleeding and a BIG hematoma at the groin puncture site (yeah, your wife's gonna love that thing next to your yule log, dude).

The admitting doc then felt a second traditional spinal tap was needed.

And that's how Mr. Traditional spent his Christmas.

When I met him (and his charming wife) this morning he asked me if I'd ever seen a case like this before.

Thursday, December 24, 2009

(For those of you who missed it the first time around, the following was my post for Christmas, 2008)

The following message was left on my office voicemail last night (December 24th) at around 8:30 p.m., by a pharmacist who was obviously less than enthusiastic about having to work on Christmas eve.

"Hello, I'm calling from Local Pharmacy about a refill for Dr. Grumpy. It's on patient Mrs. Smith, for her Cartia. The idiot's at her nursing home didn't realize she was all out until 5 minutes ago, and then were stupid enough to think they could just waltz down hereand get more. But no, there were no refills.

"So if someone could please call me to refill this, this bunch of bozos at the care home want it tonight. And I'll be here, tonight, on Christmas Eve, at Local Pharmacy, all damn night. so you can reach me whenever you call. My name is Joy. Thank you."

Crap, Local Grocery is mobbed. Hey, bitch! Don't flip me off! I wasn't even looking at that parking space. Chill.

Merry Christmas, Mr. Salvation Army dude. My only cash is $3, but I'll gladly put it in your kettle.

What a fucking mob scene. Hey! Don't push me! I didn't even want the last shopping cart! I'm just here for some damn tomatoes, lady. Merry Christmas.

Hi, it's me. I have the tomatoes. What brand of paper plates do you want? No, it looks like they're out of those. Okay, I'll get Chinet. Says they're made from recycled paper. Hope it's not toilet paper.

No, Mr. Salvation Army. I gave you my last $3 on the way in. Remember? Merry Christmas.

Hello? No, just leaving. Lettuce? Yeah, hang on. I can go back. Looks like some guy in a Santa hat is yelling at the Salvation Army guy for blocking the door, but security is leading Santa away now. Shit, somebody took my parking space as soon as I pulled out. Let me find another one.

Mr. Salvation Army, it's me again. I had to come back. You have my $3 already.

Lettuce... hey, stockperson, whatever sex you are, where's the lettuce? You only have 3 heads left? Wow. I had no idea there'd be such a rush on iceberg for Christmas. Well, this one looks like it's been dropped the least.

It's a self-checkout. Look, I don't recognize you as one of my Alzheimer's patients, but you obviously are not grasping how to work this thing. So go over to the cashier and check-out the old fashioned way. I think she's one of my dementia patients, so I'm sure you'll have a lot to talk about while you hold up that line.

What the fuck! It's not taking my credit card! All I want is one fucking head of bruised iceberg lettuce!

NO! I DON'T HAVE ANY FUCKING CASH! I GAVE MY LAST 3 DOLLARS TO THE FUCKING SALVATION ARMY GUY! IF I HAD ANY CASH DO YOU THINK I'D BE WASTING MY TIME TRYING TO PUT A SINGLE $1.29 HEAD OF LETTUCE ON A FUCKING CREDIT CARD?!!

Well, fine. I'll go over to the ATM across the parking lot. Look at that line and NO, YOU BELL-RINGING ASSHOLE! YOU ALREADY HAVE MY $3! IF I HADN'T PUT IT IN YOUR FUCKING KETTLE I'D HAVE BEEN HOME BY NOW!

This is the line for the ATM? There are 5 freaking ATM's here? Oh, great, the other 4 are all out of cash due to the Christmas rush. Fine, I'll wait.

Hello? No, I'm in line at an ATM. I need to get cash to buy lettuce and... Because I gave it to the Salvation Army guy, that's why! Look, it's taking longer than I thought!

NO, MR. SALVATION ARMY! I just got this $20 out of the ATM after waiting for 15 minutes, because I gave you my last $3 and now the credit card machine is broken, and if you approach me again I'm going to shove that fucking bell up your ass.

YOU SOLD MY FUCKING BRUISED HEAD OF LETTUCE TO SOMEBODY ELSE? ARE THERE ANY LEFT? NO? CALL THE FUCKING MANAGER!!!

Fine I'll take this bag of salad instead, but it better be for the original $1.29. Merry Christmas.

Don't even think about it, Mr. Bell Ringing Salvation Army Guy.

When I got home Mrs. Grumpy told me she'd just found an extra head of lettuce in the refrigerator. She'd forgotten she'd bought one yesterday and put it in the produce drawer.

Okay, my office is closed today, but I'm working at home, doing some marketing reviews online.

One company had me watch a television commercial in development for a new Parkinson's Disease treatment, which featured patients explaining how the disease interfered with their ability to do things they enjoyed.

One of them, I swear, was a lady explaining how, because of her Parkinson's Disease, she'd had to stop smoking, and showed a "before" clip of her trying to light a cigarette with her hand shaking all over.

Then she went on about how with new drug ParkieMiracle her coordination had improved so that SHE'D BEEN ABLE TO START SMOKING AGAIN, and showed her happily puffing away.

This ad agency really needs to be fired, or find some better examples.

We had an appointment scheduled for him, but after further review of your notes I cancelled it, as I feel seeing him at this time won't be possible.

It was very helpful that you sent his MRI reports, and the EMG findings, and the list of medications he'd tried in the past.

But most helpful was the handwritten note (and I recognize your handwriting) on the last page of the fax, which simply stated "December 14, 2009. Mr. Etoh came to appointment inebriated and punched receptionist. Police notified, patient fired from practice. Told to see a neurologist, given Dr. Grumpy's name."

Anyway, it looks like I'm not currently accepting his insurance, whatever it is (even if it's cash), and have referred him to my former colleagues at Humungous Neurology, Inc.

"Hello, um, we worked together, in 1995, I think you were in residency at the time. Anyway, I hate to bother you, but I really need some Vicodin or something called in, because I have really bad neck pain, and back then I mentioned it to you. I'm not a junkie because I used to have a nursing license and learned all about these drugs, and why you shouldn't abuse them, so if you could please call some Vicodin in to Local Pharmacy I really need it."

Sunday, December 20, 2009

I had a consult for Parkinson's disease over at Local Rehab hospital today. So I dragged my butt out of bed on Sunday and drove over there.

Parkinson's patients, unless they live in the boondocks, generally have a neurologist. Most PCP's don't want to manage this (nor should they). So when I see a Parkie in the hospital I always ask them who their regular neurologist is.

And this lady told me it was Dr. Osa, who works across the street from the rehab hospital and goes there to round. He's been following her for 5 years.

So I went back to her chart, and reviewed the records. She was recently hospitalized for hip surgery, and during the hospital stay Dr. Osa saw her EVERY FREAKING DAY and, as a consultant his name was printed at the top of every damn page of her hospital stay. But Dr. Fruitcake, who's following her in rehab, somehow didn't notice that minor detail.

So I went back and asked the patient. Did you tell Dr. Fruitcake you see Dr. Osa? "Of course I did, but she never payed attention. She just said she'd have a neurologist come see me."

So I asked the charge nurse. Did Dr. Fruitcake even look at the hospital records? "Of course. I handed them to her myself. She gave them back to me and said to put them in the chart. She told me that she never wastes time looking at hospital records because she has a busy life."

I changed the consult to Dr. Osa, and called him myself. He'll be in later today.

I drove home, an hour wasted.

Dr. Fruitcake, READ THE FUCKING CHART. If you don't have time to take proper care of patients then get out of medicine.

I hadn't been in a hospital since I was born, and of course I don't remember that.

But my asthma was not getting better that week (I was on Marax- you RPh people remember that?) and so, after repeated visits to his office, my pediatrician admitted me to Local Hospital.

My most vivid memory is watching "The Year Without a Santa Claus" on TV ("I'll have a blue Christmas without you...). It was the only thing I remember being on. Maybe that's why, ever since then, I've been oddly partial to the "I'm Mr. White/Green Christmas" musical numbers.

Yes, kids, back then you had to PLAN your holiday-TV-special-watching. It wasn't as simple as just, say, finding which of the 182 channels were showing it on any given night, or popping the DVD in whenever you wanted. A motivation to learn to read was so you could look through TV Guide and make a list of when and what channel each of the key specials was on. Because if you missed them, too bad. They wouldn't be back until next year. So, no matter where you were, you found a way to watch them.

I also had to learn to pee in a urinal. But, I digress.

I thought I was a good patient. I really did. I don't remember pressing the call button much. My breathing got better. I went home the next day.

And now let's fast-forward to the mid-90's.

Studly, white-coated, intern Dr. Grumpy, fresh out of med-school, is now doing his training at the very same hospital where he spent that night long ago. And one day, while waiting for an admission to come out of the MRI, he wanders down to medical records, looking for that long ago chart from 1974.

Down 2 flights of stairs, in a dimly lit basement, they still had it. It was on microfiche (remember that, people?). I sat down and perused the notes out of curiousity. Reading off asthma drugs long withdrawn from the market.

And then I came to the nurse's notes.

And my nurse that night had written "Patient won't stop whining."

WTF! You bitch!

Me? Whine?

I didn't whine! I was sick, damn it! And my IV hurt! And the hospital food sucked! And the TV reception could have been better! And you put the urinal where I couldn't reach it! And you kept waking me up for that breathing treatment! And I needed another blanket because you kept my room pretty freaking cold! And you had coffee-breath!

I put the chart away. I was curious. I called the pediatric floor to ask if she still worked there.

Friday, December 18, 2009

If you're going to fake illness/trauma/death to get out early on the last day before Winter Break, here are some tips for next year (since today's attempts failed).

1. Know where your freaking appendix is. Pointing to the left hip is not going to score points. Moving your finger around and trying to get me to say "warmer" or "colder" will not work. I am not stupid.

2. If you come in weekly claiming to have appendicitis, don't even bother to do it today.

3. After I send you back to class, calling your mother (or, better yet, 911) from your cell phone to complain that you're being mistreated and ignored by the school nurse does not help your cause. There is a reason my office is right across from the Principal's, and my door is always open. Everyone can witness what is going on in here. In fact, you aren't supposed to be using your phone during school hours. Now that you did (and for a bullshit reason) it will be confiscated if you bring it back in January. And I don't care whose greatest hits you have on it.

4. If you don't want me showing your Mom my list of all the times you bring your lazy butt in here for a stomach ache (which I write next to what classes and tests you had at those times) then don't tell her to come talk to me about how I'm not caring for you properly.

5. The "fibulia bone" is NOT in your arm (in fact, it doesn't exist, but I assume you can't spell either). So don't tell me you broke it, and hold your arm. Coming in claiming that your left arm is hurting, and favoring your right arm, doesn't help. Neither does limping when you come in for arm pain.

Before we met, Mrs. Grumpy was a cancer nurse, specializing in chemotherapy. She worked at the infusion suite of Local Cancer Center.

As you've heard me complain, in December all medical practices get trays of food and/or flowers from different ancillary businesses, thanking them for their support in the past year.

So one busy mid-December morning a delivery guy dropped off a HUGE floral arrangement on the front counter. Since it was busy, and the flowers were pretty, the staff just left them there.

Oncology clinics are never cheerful places, but that morning there seemed to be a larger-than-usual number of patients and their families crying in the lobby. But nobody mentioned anything to the staff, so work went on as usual.

Sometime in the early afternoon a secretary took the flowers back to the break room, so the rest of the staff could enjoy them.

At that point they realized the side of the display that had been facing the lobby had a large note that said:

"Thank you for your referrals over the past year. From the staff at Local Mortuary."

The item has been around for at least 2 years, and always shows up in December. A gift for that truly desperate person in your life.

(click to enlarge)

I've seen various models of it. Another catalog (which Frank colored in, so I couldn't use the picture) had one that actually (I swear!) was powered by AA batteries and said: "It vibrates soothingly, just like a real man!"

I suppose this is true, provided your idea of a "real man" is headless, legless, one-armed, half-torsoed, and "vibrates soothingly".

Thursday, December 17, 2009

"Clinically, the patient has clinical features of dermatomyositis as noted in clinic today. His clinical exam and lab reports support the clinical diagnosis. So, on a clinical basis, I think he has it."

Wednesday, December 16, 2009

The glass doors in front are heavily darkened. You can see if there's someone on the other side (so you don't whack them) but they're too dark to make out any details about them.

As I'm leaving with my Bag-O-Dinner, I was starting to push the door open. At the same time a child suddenly appeared on the other side of the door, starting to come in. He jumped back as I pushed the door open, and I almost hit him with it.

English is an odd language. Being a native speaker, it seems pretty easy to me. But I'm generally lousy at other languages. I took 2 years of Spanish in high school and 4 in college, and I still can't speak it worth crap.

Some of the phone meetings have been outsourced overseas, so occasionally I find myself chatting with someone who speaks English, but with a non-American accent. Occasionally it's someone to whom English is a second language, though usually they're still quite good at it. And that's the situation I found myself in yesterday morning.

The study was on my interactions with drug reps, given by a lady with a mild, nonspecific, accent, but her English was still quite good and understandable. Unfortunately, it was also very old-style, and oddly formal, with phrases and words that aren't used much among modern English speakers. Understandable words, just a little odd.

Most of them were minor, but one was an issue. She used the old word for personal interaction.

Which is "intercourse".

Yes, I know it can mean ANY kind of personal interaction, and the technical phrase for sex is "sexual intercourse". But it's been shortened over time, to where now intercourse just means you're doing the wild thing.

And I'm a veteran of crazy patients, and having to keep a straight face. And I freaking lost it here, (thank heavens for the phone mute button) and at one point had to run to the john to keep from peeing myself (I told her I was going for a Diet Coke).

Here are some of the questions:

"How many times a day do you have intercourse with drug reps?"

My inner voice: It's variable, depending on the time left after I have intercourse with patients.

"If a drug rep provides lunch for your office, are you more likely to have intercourse with them?"

December, at least for me, is the worst month in my practice. The schedule is usually half-empty as people try to postpone things to after the holidays ("maybe my right arm will start working before the new year"). Patients have a million things come up at the last minute and can't come in. Most irritatingly, my epilepsy patients always get so damn busy that they forget to take their pills, and then have a seizure, and then get angry at me because they can't drive for a month and go Christmas shopping. Like it's MY fault!

But the biggest office issue this time of year is food. The holidays offer a perfect storm.

Like many medical practices, my staff and I depend on drug reps to help supply our nutritive needs. We average 2-3 drug company lunches (occasionally breakfasts) per week, and with the leftovers get 5 days out of it. Sometimes even enough to take home.

But in December, that starts to vanish. Many reps take vacations, or have mandatory time-off. A lot of them find they've gone over-budget for the year, and so to balance it out they cut lunches in December. So we're left with the prospect (gasp!) of foraging for ourselves!

The converging issue that makes this worse is what does come to the office. Every MRI place, lab, physical therapist, pharmacist, and grateful patient sends us trays of stuff. And not healthy stuff, either. Cookies, cakes, pastries, candies, cupcakes, donuts, chocolate covered anything, and other stuff. By the boatload.

So we eat this shit instead. And with fewer patients, we have more time to hang out in the back and chat and eat. And since we are all trying to save money for holiday gifts, we don't want to go get something healthy (like at McD's or Taco Bell).

(There are other options- a diabetes specialist down the hall from me puts all the sweets out in his lobby for the patients. Really.)

So our lunches become a selection of cookies, a few chocolates, and maybe a piece of pie (hey! it's apple pie! Isn't that healthy?).

And it's in this condition that I have to face my evil arch-enemy, the Wii Fit Trainer, who just delights in telling me how much my weight has gone up.

Fortunately I have the new Wii Fit Plus. And so far I've been killed repeatedly by giant wrecking balls on the obstacle course. It's so depressing I'm going to go have a cookie.

Sunday, December 13, 2009

Sorry about our little dispute at the school last week. Normally I don't take the kids in the morning, but Mrs. Grumpy had an early meeting that day.

It must be nice having a child that is naturally compliant with your orders. Frank, however, is not like your daughter, and will fight us to the death about wearing a jacket. Getting him to wear a sweatshirt over his clothes took an act of Congress and delicate negotiations. While it's not perfect, it was a halfway compromise.

So far he hasn't frozen to death or caught pneumonia/swine flu/AIDS/cooties/halitosis, or any of the other disorders that you seem to think are floating through the air specifically targeting unjacketed children.

But I'm glad you were concerned enough about someone else's kid to take the time out of your busy day, walk over to me, and make a scene in front of all the other parents about how you've been watching the "horrible neglect" practiced by my wife and I. I appreciate you running down a list of communicable airborne illnesses that you got from Google, and closing your argument by threatening to report us to Child Protective Services if you ever see my kid without a jacket again.

I think it's great that you want to pay such close attention to the failings of us lesser parents. Reminded me of the Charlie Brown cartoon where Lucy took it upon herself to write New Year's Resolution lists for everyone else.

I really like the way you punctuated your tirade by slamming your daughter's car door, HARD, to make sure we were all paying attention. We definitely all were (except your daughter, who looked too terrified to speak) because me, 3 teachers, and 20 other parents immediately began trying to tell you that you'd just slammed one of her backpack straps in the door. But you were clearly more concerned with my crappy parenting skills to notice.

Fortunately, your child had the presence of mind to let go of the other strap after she'd been pulled down and dragged about 3 feet as your drove away. And I have to admire the teacher who boldly leaped in front of your car to make you slam on the brakes, at the risk of her own health.

Your kid will be okay, I swear. She has a small cut on one hand, and a tear in her jacket where it got dragged (maybe you should get her a new one).

I felt so awful about it too. You made me feel very guilty when, after you checked your kid and released the backpack strap from the car door, you turned to me and yelled, "Now look what you made me do!" before getting in your car and driving away.

Saturday, December 12, 2009

(I have no idea who wrote this, or where it started. It gets circulated by email so much I'm sure many of you have seen it. But it's still entertaining)

Subject: Holiday News Release

THE NORTH POLE (Reuters) Continuing the economic trend towards monopolies, it was announced today at a press conference that Christmas and Hanukkah will merge. An industry source said that the deal had been in the works for about 1,300 years.

While details were not available at press time, it is believed that the overhead cost of having 12 days of Christmas and 8 days of Hanukkah was becoming prohibitive for both sides. By combining forces the world will be able to enjoy consistent quality service during the 15 Days of Christmukah, as the new holiday is being called.

Massive layoffs are expected, with lords-a-leaping and maids a-milking being the hardest hit.

As part of the agreement, the letters on the dreidl, currently in Hebrew, will be replaced by Latin, thus becoming unintelligible to a wider audience. Also, instead of translating into "A great miracle happened there," the message on the dreidl will be the more generic "Miraculous stuff happens." In exchange, Jews will be allowed to use Santa Claus and his vast merchandising resources for buying and delivering of their gifts.

One of the sticking points holding up the agreement for at least 300 years was the question of whether Jewish children could leave milk and cookies for Santa after having eaten meat for dinner. A breakthrough came last year, when Oreos were finally declared to be kosher. All sides appeared happy about this development except for Santa's dentist.

A spokesman for Christmakuh, Inc., declined to say whether takeovers of Kwanza, Solstice, or Festivus might not be in the works as well. He pointed out that were it not for their independent existences, the merger between Christmas and Hanukkah might be seen as unfair cornering of the holiday market. Fortunately for all concerned, he said, the other holidays will help to maintain the competitive balance.

He then closed the press conference by leading all present in a rousing rendition of "Oy, Come All Ye Faithful."

Hitting the snooze button too many times? Or are you a 4-wheel drive aficionado that thinks every household appliance should be an all-terrain-vehicle? Or both?

Now, you can truly have it all! An alarm clock that not only wakes you up, but leaps off your night table, forcing you to chase it!

(click to enlarge)

I know this would work at my house, but only once. The alarm might not wake me up, but Blackdog frantically barking at it rolling across the floor would, and then I'd have to get up to clean the puddle where terrified Snowball pissed on the carpet when he thought it was coming to get him. And I wouldn't need to hit the snooze button because in the next minute psycho Cooper would tear it to pieces. And $39.95 seems like a lot of money to me for a 1-time-use appliance.

Friday, December 11, 2009

The phones have been ringing busily today, and so a few calls went to voice mail. Annie had me listen to this one. She was laughing so hard she ran to the bathroom so she wouldn't wet herself.

"Hi, this is Suzy Frazzled. I'm a social worker involved in the medical case of Kathy Smith. I'm calling to see if you have any records on her. You probably don't, because none of the other doctors on the list she gave me have ever heard of her, either, and I'm on my last damn nerve dealing with her. Anyway, she's blaming every freaking illness she has, like Fibromyalgia, Restless Leg Syndrome, asthma, arthritis, back pain, irritible bowel syndrome, fatigue, fungal bladder infections, and a bunch of other junk, all on a freaking piece of cotton that was left in her ear 2 years ago after she had a glob of wax taken out. She thinks she's won the freaking lottery, apparently. What? No Bob, I don't have that info here. I've been working on Mrs. Smith all damn morning. How come you don't get these? The boss gives me all this shit, and it's not fair. Where the hell do these people come from and why do they always end up on my freaking desk? Why can't I get normal cases? Oh, sorry, hello? Anyway, please call me back and let me know if you've ever heard of this lady and have a happy holidays."

The official Grumpy family Christmakuh tree is up, and I want to wish my Jewish readers a very happy Hanukkah.

For those of you unfamiliar with Tom Lehrer's remarkable work, I suggest you learn more. He is one of the very best musical comedians EVER, with, oddly enough, advanced degrees in science and mathematics. Other brilliant works include The Elements, Pollution, Smut, The Hunting Song, I Hold Your Hand in Mine, and many others. For those who (like me) grew up watching The Electric Company on PBS, he wrote a number of those catchy tunes, such as L-Y and Silent E.

If your specialty pharmacy mail-order branch is handling my patients' potentially dangerous injectable drugs, it would give me (not to mention them) A LOT more confidence if you knew how to spell your own job title.

Wednesday, December 9, 2009

Mrs. Lumbar: "Well, my husband has a set of exercise balls, not the huge ones, but the small ones you roll across your muscles, and the pressure from those helps. So I'm able to get comfortable and sleep, but only if I spend the night lying across his balls".

I'm sorry about the way things went at your appointment yesterday. I guess you and I just didn't have great chemistry.

I can understand you being frustrated with me. Obviously, a man of your means is used to people kissing his ass constantly. But here at Grumpy Neurology, it doesn't buy you much. Let's face it, Medicare pays me the same amount to put up with you as it pays me to put up with Mr. Nice Butpoor. If you were paying me $1000/hour to listen to your stories about the yacht club I might be more inclined to do so. But I'm only going to get Medicare's flat $115 for you, and my billing company gets 10% of that, and I have to pay Mary, Annie, my rent, the Diet Coke bill, and my malpractice insurance out of the rest.

Anyway, we were obviously off to a bad start when you told Mary that your regular doctor (who you pay cash to) dresses up for you. And this was before you even had a look at me. You also were not happy that, when you asked Mary what kind of refreshments we offer for waiting patients, she pointed to the water cooler.

I SO enjoyed being grilled over my credentials. I really am a doctor, I swear, not some homeless person who decided to rent an office, hire some staff, and buy some cheap office furniture just for the hell of it. You were clearly not impressed that I went through public schooling most of my life. Of course I've heard of your alma mater, but it was so much more fun to watch the horrified expression on your face when I pretended I hadn't, and then asked you if it was in Arkansas. The devil made me do, what else can I say?

I think we reached the low point during the appointment when, after I'd spent 30 minutes taking your windy history, and another 20 minutes examining you, your heavily plasticized wife (who may be putting arsenic in your prunes- watch out) asked me "So when will the doctor come in to talk to us?" That made me feel real special.

So when I heard you tell Mary that you didn't want to schedule a follow-up with me, and wanted to discuss matters with your internist, I knew this translated to "I'm never coming back here and am complaining to my internist about you". And guess what? I don't care.

Be careful the automatic door doesn't hit... oh, sorry, guess I should have warned you sooner.

Tuesday, December 8, 2009

For those of you still looking for that perfect gift, here's another great idea!

Dogs give you unconditional love, but is that really good enough for you? Wouldn't it be important to know just how many breeds are represented in your mutt? Or is your "purebred" really that? And maybe you'd love your poodle less if you discovered he had a trace of beagle in his lineage?

I wish to point out that Dr. Grumpy beat him to press with this important breaking news by several hours, and his column was not leaked to me in advance (unless you consider the catalog being sent to my home to be a leak).

Monday, December 7, 2009

This is Mrs. Grumpy. He didn't want to hear me bitch about my day at the school, and told me to tell you guys. So here.

School nursing brings you an amazing collection of hypochondriacs, and it gets worse with winter break coming and they get restless. So today, besides the usual collection of snotty noses, stomach aches, and "I can't do PE because..." I had this.

"I've been using crack since I was 18, and I'm 27 now. I mean, that's almost 7 years I've been doing this stuff. I've spent 2 years in jail for it. I've been in and out of every rehab program in town. I've never had a real job, and still live with my parents. It's time for me to turn my life around, and I'm going to start by being honest and telling my parents about my habit. I've been able to hide it from them, but It's time they know I've got a problem."

Sunday, December 6, 2009

Yesterday I admitted a lady in her 50's who had a stroke. So I'm rounding on her this morning.

Mrs. LDL: "Doctor, I'm changing my whole life right now! I'm going to start being healthy. For many years I've always had a cheese omelet for breakfast. So, today, when they took patient breakfast orders, I realized I had to start doing things differently."

Saturday, December 5, 2009

With the pentuplet of seasonal holidays approaching (Hanukkah, Festivus, Christmas, Kwanzaa, and Solstice), my home mailbox is full of catalogs selling all kinds of things that these people apparently feel my family and friends can't live without.

Since so many of my patients call my office asking if we have any gift ideas (NO! I HAVE ABSOLUTELY NO FREAKING IDEA WHY THEY CALL ME!!!) I figure many of you are dying to do the same (Dr. Grumpy merchandise is always nice).

So I've personally combed through these many catalogs to help you, my loyal readers, find some of the most useful gifts out there, and will present them over the next few weeks.

Today I'm going to kick off the list with this tasteful item:

Yes, it's a shower soap dispenser (comes with green gel soap! Wow!) that dispenses soap out of it's nostrils. I suppose next year they'll have one that makes a sneezing noise when you squeeze it.

I'd order one for that special coworker who continuously complains about allergies and leaves wadded-up Kleenex all over the office.

It is NOT, generally speaking, normal for you to be woken at night by your guy shaking the bed violently, turning blue, and peeing on the sheets. If he does this, and hasn't done it before, he needs medical attention.

You also should not allow this to go on for several nights in a row, and then call his mother to see if she can help you wash all the bedsheets, and (when she asks you why), let her be the one to make the CORRECT decision that he should go to ER.

It is also not cool that you sent him in by himself, so you could stay home and catch up on washing sheets. Your description of the events is usually helpful to those of us in the "med-biz".

While rounding, I was paged overhead to come down to ER for a stroke that had just arrived. Guy who can't move his right side.

So I'm sitting here in ER, watching him from the nurses' station, waiting for my turn to go in. Nurses are hooking him up to stuff, techs in there drawing blood, an EMT going over info with another nurse.

In the middle of this all the patient is lying there, calmly texting with his left hand.

I pull into the driveway, and walk down to the mail box to get the bills & junk. The neighbor family is out putting up some Christmas lights. Mr. Neighbor comes over to chat for a minute.

Suddenly, my front door flies open. Frank comes out, screaming at the top of his lungs.

Frank: "DAAAAD!!! THE FRONT HALL TOILET BACKED UP ON ME 'CAUSE I USED TOO MUCH PAPER AND NOW THERE'S POOP ON THE FLOOR AND SOME STILL IN THE TOILET AND PAPER EVERYWHERE AND IT SMELLS BAD AND THE TOILET KEEPS RUNNING AND..."

Thursday, December 3, 2009

Things are tough all over. Occasionally I get patients asking me if I'll forgive their appointment co-pay. Usually I can't, because most insurance contracts forbid it, and because I'm trying to stay afloat, too.

So today I had a lady tell me she can't afford her $25 visit co-pay, and could I PLEASE write it off? She used the "I need the money more than you do" line.

I know she has legitimate financial hardships, but I refused.

Why?

Do I need the $25 that badly?

I did it because she smokes 2 packs a day. And ADAMANTLY refuses to quit.

Let's look at this:

The average price of a pack of cigarettes in the U.S. right now is $5. This varies by brand & your state taxes, and whether you buy them by the pack or case. But roughly $5 a pack.

So for her, that's $10/day. Or $300/month. Or $3600/year.

I told her that. If she quits smoking, that would be like her getting a $3600 annual raise, without any additional taxes. Ignore the health benefits, just look at the money alone.

All that money for making one life change. That would help her financial situation A LOT. It's a hell of a lot more money than making a $25 co-pay once or twice a year.

Wednesday, December 2, 2009

But sometimes I MUST make an exception when I see something so good, so clever, that I want to share it and say LOOK AT THIS! IT'S FREAKING AWESOME!!!

And when I do that, I make sure I properly credit it.

Maybe it's because I'm a literature buff, and took too many of those classes in college. Edgar Allan Poe is featured in most of them, and his most famous work is The Raven.

So on reading other blogs today, I found this excellent post written by Maha. She's an ER nurse who writes Call Bells Make Me Nervous. Check her site out. And Maha, please forgive me, but I just had to share your remarkable piece of writing.

So, without further ado, I present Maha's satire on The Raven. It's called The Drunkard.

Had Edgar Allan Poe Been an Emergency Nurse…

The Drunkard

by Maha

Once upon a midnight dreary, while my back ached, weak and weary,Over many a quaint and curious patient at the triage door.While I nodded, nearly napping, suddenly there came a tapping,As of someone rudely rapping, rapping at my triage door."'Tis no drunkard," I muttered, "tapping at my triage door--A well man and nothing more."

Ah, distinctly I remember the bloody night before November,And each and every staff member had brought a patient to the floor.Eagerly I wished the morrow, vainly I had sought to borrow,From my books of assessments thorough –to avoid the cookies from days of yoreAnd drink my latte from so long before.

But the stinkin’ sad uncertain shuffling of a drunkard’s gait that’s strugglingThrilled me – filled me with supreme annoyance, never felt before.So that now to still the beating of my heart, I stood repeating“Tis no drunkard entreating entrance at my triage door –Some late UTI-er entreating entrance at my triage door;This is it, give Toradol galore”.

Towards the patient I finally headed, hope for sleep completely shredded,“What,” barked I, “please don’t have a complaint I’ll deplore,But the fact is I was napping and so intently you were tapping,And so rudely you came slurring, ranting at my triage door”.And without regard or thinking, he barfed upon my triage door,Chunky vomit and lots more.

Then, of course, the air grew denser, thanks to the obscene Spencer,A man now pickled, whose foot-falls dragged in the department’s floor.“Wretch,” I cried, “why did God bring thee – by the devil he hath sent theeRespite – respite and Valium please for thy abnormal CIWA scoreWhy, oh why this loud decree of your drunken presence on my door?!”Screamed the drunkard, “I barfed some more”.

"Spencer!" said I, "this stench is evil!--Spencer this is the needle’s bevel,Whether taxi sent, or whether ill-fate tossed thee here ashore,Desolate, yet all undaunted, in this department un-enchanted,In this hallway by Horror haunted--tell me truly, I implore--Is there--is there calm from Gravol?--tell me--tell me, I implore!"Quoth the drunkard, "I need lots more."

"Spencer!" said I, “more upheavals? - Spencer still, if man or devil!By the score of twenty and eleven – by the Valium we both adore –Tell this nurse with sorrow laden, who to call? Perhaps thy maiden?Please, oh please, I beg thee, use the bucket on the floor.”Quoth the drunkard, "Nevermore."

"Be that word our sign of parting, man or fiend!" I shrieked, upstarting."Get thee out of the department and save my night from being abhorred!Leave no chunks of vomit as a token for my tolerance thou hast broken!Leave here with this train token! – Quit the bed and leave the main floor!Take thy stench as you depart, and take thy form from out the door!”The drunkard started to loudly snore.

And the drunkard, unremitting, still is snoring, still is snoringOn the pallid stretcher mere inches from the door;And his socks have all the seeming of a mold that is steamingAnd the lamp-light o’er him streaming throws his shadow on the floor;And my break retreating into shadows that was planned for four,Shall be taken – nevermore!

Okay. Your epilepsy has been stable for over 20 years. In fact, I only see you once a year for it, and refill your Tegretol while we chat about sports, weather, whatever.

Your medication dose hasn't changed since the 80's, back before I even went to med school.

I write you a new script once a year, that you fax to your mail-order pharmacy.

Normally I see you in January, but you had to move up your appointment since you'll be out of town next month. So you asked me to date your next Tegretol script for January 1, 2010, and you won't send it in until then. Fine. I did just that.

So, after I've given you a post-dated script DON'T FAX IT TO YOUR FREAKING PHARMACY WITHIN AN HOUR OF LEAVING MY OFFICE!!!

Now I've got the pharmacist calling, wondering if I'm demented and don't know the date (not an unreasonable thought). I'm pretty sure he doesn't think you have some sort of special time-traveling fax machine at home.

So don't do it again. Put the script on your refrigerator and don't cash it in until January 1, 2010 LIKE YOU TOLD ME YOU WOULD and we'll all be happy.

When I was doing my internal medicine residency, another doc in my class was a girl named Christine. She was just doing a 1 year internship before going on to radiology.

She was a good person, and a good doc. But she was a HORRIBLE black cloud. Bad luck just followed her and her patients, in spite of the fact that she took damn good care of them.

She just had remarkably shitty luck. When she was on call, her service would always max out with admissions, and they were all really sick. Codes would occur. Her patients seemed to die more often then anyone else's. And, again, this was just bad luck. She was a good doc, just always seemed to get the sickest patients.

After the first 6 months of this, she was so burned out that she needed a vacation, and booked a cruise.

On the first night of her cruise, the guy sitting next to her at dinner collapsed and died from a peanut allergy.

(I am not a marketing person. I don't have the personality, or the mindset, or the training. So this story only barely makes sense to me. I'm sure the marketing or business people out there will tell me this is perfectly logical).

Extavia!

Isn't that a great name?

I have to wonder how much they paid the person who thought it up. It has a cool ring and the letters "X" and "V" (according to my friends who do sales, these, along with "Z", are considered "power letters", and putting them in words is supposed to connote something impressive).

With a name like that you'd think the drug was new, powerful, groundbreaking.

Extavia! NEW! For Multiple Sclerosis!

Released to the neurology world recently with hoopla, ads, drug rep lunches, etc.

Would you believe that Extavia is over 15 years old, and is being used to launch a drug that isn't even on the market yet?

Here's the story: Betaseron (Beta Interferon 1b) has been on the U.S market since the early 90's. It was the first drug ever approved for MS, and certainly is a decent drug. I prescribe my share of it. It's manufactured by Bayer.

Novartis, another pharmaceutical company, is developing a new MS drug, which it hopes to bring to market in the next 6-18 months.

But Novartis has no MS drug currently out there (though they do have 3 big neurological ones under patent). So they decided that, to get a foot in the MS marketing door now, they should hire a bunch of new reps (though they already have a fairly well-trained neurology sales force), and train them to market MS drugs. This is hard to do when you don't have one.

So they bought a license from Bayer to sell Betaseron, too, to get their reps some practice. But, since they didn't want to market plain old, early-90's Betaseron, they renamed it Extavia! New name! New marketing! Same drug! Same dosing! Same everything except the name (actually, I think the price is slightly lower)!

And, of course, Betaseron is still on the market. In fact, Bayer is making all the Extavia, too. So Bayer is likely going to clean up on the deal, since they get paid regardless of which gets prescribed.

I suspect Novartis will not make money on this, and is using Extavia as a loss leader, hoping to make the money back when the new drug comes out in a year or two.

On the one hand, I think it's good that they're hiring a new sales force to sell Extavia and future drug. Certainly, jobs are good for the economic recovery.

But on the other hand, it still seems kind of silly to me. Like I said, though, I'm not a marketing person.

I know you're pregnant, ma'am, and I understand your concerns about not wanting to take a medication because it might harm your baby. I don't prescribe pills just for the hell of it, and try to weigh the risks and benefits.

But DON'T tell me that you're worried about the effects of the pills on a fetus when you just told me you smoke a freakin' pack a day, okay?

"Can someone call me with your phone number?" (DUH! YOU JUST CALLED ME!)

"Is my MRI on Thursday or Friday?"

"Did I miss my appointment 2 weeks ago?"

"Can I find your office on Mapquest?"

"What kind of doctor is Dr. Grumpy?"

"Can I have my driver's license back so I can go Christmas shopping?"

At 8:30 a.m. tomorrow morning the phones will be rolled back, and you can start hassling Mary and Annie for questions about your tests, appointments, insurance authorizations, good shopping deals, safe ways to hang lights, and a myriad of other questions.

"Hi, I saw Dr. Grumpy in 2007 or so, and had hurt my neck back then, and physical therapy helped. Anyway, I hurt it today carrying a bunch of boxes that my wife just HAD to get on Black Friday, and some asshole pushed me out of the way in the Wal-Mart toy section, and so I'd like to get some more therapy. It's hurting a lot right now, and I thought maybe there was a 24-hour therapy place you could send me to. Also, my internist said I'm due for a cholesterol panel, and something else to check my liver because I take a pill for my cholesterol, it's one with a long name, and maybe you could order those labs for me, too."

Off the medical and humorous topics, I'm going to indulge my interest in maritime history this morning.

Everyone's heard of the Titanic, Andrea Doria, and Lusitania. But most shipwrecks are long forgotten, except in the areas they occurred.

Long before The Perfect Storm was made famous by a George Clooney movie, there was the Portland Gale of 1898. The storm was catastrophic, but is mostly forgotten now.

In 48 hours of early-winter gale over 300 ships were either sunk or seriously damaged. Lives lost is unknown, but likely between 500-1000. Shore towns and cities from Massachusetts to Maine were devastated by rain, sleet, and more than 2 feet of snow, driven by winds measured up to 110 miles per hour. Communities of summer beach cottages just vanished.

But the storm is still called by the name of it's most prominent victim: the steamship Portland.

In 1898 the Boston, Massachusetts to Portland, Maine route was a busy one, used heavily by both business and leisure travelers. Some took trains, while others preferred steamship. The latter traveled on coastal steamers, usually by night (the equivalent of a "red-eye" flight today). A ticket was $1 to $5, depending on your accomodations. You'd board in the evening, have dinner on the ship, sleep in your cabin, and the next morning were there. The ships went back and forth 3-4 times a week.

The New England weather can be notoriously vicious. A storm was coming in when the Portland sailed on the evening of November 26, 1898. Her captain, Hollis Blanchard, was known for being cautious, but apparently saw nothing in the conditions or forecast that unduly alarmed him. At 7:00 p.m. the ship sailed from India wharf in Boston, never to return.

The ship was sighted by others in the next few hours, but as the storm worsened, eventually vanished in the gale. When and exactly how she foundered will always be a secret, as she took all 192 passengers and crew with her. Recovered watches had all stopped between 9:00 and 10:00, though whether this was a.m. or p.m. is unknown.

The next day wreckage began washing ashore: furniture, timbers, luggage, lifebelts, and lots of bodies. Although the picture above shows a lifeboat being launched, none were ever found, and the severity of the storm makes it unlikely this was even attempted.

Several entire families were lost in the tragedy, traveling home after Thanksgiving in Boston. Their memorials are scattered across New England graveyards. The Portland black community was hit particularly hard, as (except for the officers) the majority of the crew were black men. In 1898 (33 years after the Civil War) service on these ships was considered a very respectable job for a black man, and those who served were generally veterans of the trade, supporting families ashore. They were often more sought after than white men for the same positions, as white men looking for these jobs were younger, less experienced, and seen as more likely to leave the job without notice.

The Portland herself would remain hidden for a long time. In 1989 the wreck was actually located, but the technology wouldn't allow an accurate identification. So it was forgotten again until 2002, when it was found by side-scan sonar. It's since been explored by divers, though at a depth of 460 feet in very cold water this is limited and dangerous.

So that's a history lesson for Friday. It seemed like a change of pace, and I needed to write a post, and I hope you enjoyed it. If you're interested in learning more about the Portland and 1898 gale, I recommend the book "Four Short Blasts" (the title refers to the whistle distress signal of the time) by Peter Dow Bachelder. The book also has a brief history of the American Life-Saving Service, which eventually became the U.S. Coast Guard.

Thursday, November 26, 2009

Dr. Grumpy is the medicine intern, on-call for Thanksgiving, at a large VA hospital (a veterans hospital for my non-U.S. readers, with consequently a primarily cantankerous elderly male population).

A peculiar thing about VA hospitals (at least back then, I haven't worked at one for 15 years) is that patients could sign out at the nurse's desk, and come back later (allegedly they were in the hospital because they were sick, but you need to work at one to understand this point). So the sheet was always full of notations that patients had signed out to go to McDonald's, or to buy cigarettes, or to smoke, or to visit friends at the homeless shelter, or to hold up a liquor store, or whatever.

Some bright businessman had opened a stripper club across the street from the hospital, I think it was called The Jaguar Room. So on Thanksgiving the VA ward I was covering was empty, as most of the patients had signed out to walk, wheel, or crawl over to The Jaguar Room for some female comfort and booze.

I was asleep in the intern's room when the calls began coming in. All of them from the bartender at The Jaguar Room. Questions about was it safe for my patients to be smoking through their tracheostomy tubes? Were the cardiac telemetry packs still transmitting from across the street? Was there a place at the VA where the patients could get more $1 bills, because they'd used them all up on the strippers?

And my favorite:

Bartender: "Can I give Mr. Veteran another beer?"

Intern Grumpy: "Um, what's the problem?"

Bartender: "He has one of those foley bags things, with the tube going up his dick. The bag is, like, REALLY full, and I'm afraid if I give him another beer it'll pop and send piss everywhere."

Intern Grumpy: "Send him back to the hospital."

Bartender: "Well, that's bad for business."

Intern Grumpy: "So is showering your clientele with piss."

Mr. Veteran was wheeled back over to the VA immediately, by a topless stripper no less, who waited while his bag was emptied and then pushed him back to the bar.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

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Dr. Grumpy is for hire! Need an article written (humorous, medical, or otherwise) or want to commission a genuine Grumpy piece for your newspaper/magazine/toilet paper roll? Contact me to discuss subjects. You can reach me at the email address below.

Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.